How to request NECoMG membership

Thank you for your interest in The Northeast PHO. The first step in joining our network of physicians is to request NECoMG membership. To ensure a smooth enrollment process and to minimize potential delays with insurance credentialing, the PHO recommends that you request NECoMG membership at the same time that Beverly Hospital privileges are being requested.

If a provider does not already hold Beverly Hospital privileges and has not already requested a privileging application, please reach out to Beverly Hospital Medical Staff Office (MSO) to request an application.

Amy McIntire
Manager, Medical Staff Office  
Phone: 978-816-2841
Fax: 978-921-7048  

From the PHO perspective, the Provider Relations Department will need the following items to bring a new provider to a monthly NECoMG Board meeting for approval to become a Northeast PHO member and link to our health plan contracts:

  • Copy of CAQH application (Instructions)
  • Confirmation that Beverly Hospital application process is underway
  • CV in month/year format
  • Completed NEPHO Data Form
  • Plan participation form
  • Copy of current malpractice facesheet
  • Copy of board certification or proof of board eligibility
  • Copy of Physician Supervision Agreement/Admitting Arrangement (Applicable to Advanced Practitioners only)

Please send required documents to Alycia Messelaar, If you have questions regarding the NECoMG on boarding process, please call 978-236-1784.